Kenji Shimodaira

The powerful impact of double-layered posterior rhabdosphincter reconstruction on early recovery of urinary continence after robot-assisted radical prostatectomy

BACKGROUND AND PURPOSE The usefulness of posterior rhabdosphincter reconstruction (PR) during robot-assisted radical prostatectomy (RARP) has still been controversial. We investigated the association of several factors, including the Rocco original double-layered PR, with early recovery of urinary continence after RARP. PATIENTS AND METHODS Between August 2006 and April 2011, a single surgeon at Tokyo Medical University Hospital performed 206 RARPs. Of these 206 patients, 199 eligible patients were enrolled in this study. We retrospectively analyzed the correlation of several perioperative factors, including surgical techniques, with early recovery of urinary continence 1 month after catheter removal. Continence was defined as no use or the use of only one safety pad. RESULTS Univariate analysis showed that surgeon experience, lateral approach of bladder neck preservation, bladder neck reconstruction, anterior reconstruction, and the Rocco double-layered PR were significantly associated with early recovery of urinary continence 1 month after catheter removal. Preoperative prostate-specific antigen level, body mass index, and attempted nerve-sparing (NS) procedures, however, were not significantly associated with early recovery of urinary continence. Multivariate logistic regression analysis showed that the Rocco PR and attempted NS were the only independent predictive factors of urinary continence recovery 1 month after catheter removal (odds ratio [OR], 15.01; 95% confidence interval [CI], 3.413-66.67; P=0.0003 and OR, 2.248; 95% CI, 1.048-4.975; P=0.0402, respectively). When we applied NS as well as the Rocco PR, the recovery rates of continence at 1 month after catheter removal was 85.3%. CONCLUSIONS The Rocco double-layered PR and attempted NS and not surgeon experience were the significant independent predictive factors of early recovery of urinary continence after RARP. NS procedures positively influenced early recovery of urinary continence only when they were applied with the PR technique.

Emphysematous cystitis following a transrectal needle guided biopsy of the prostate

BackgroundEmphysematous cystitis (EC) is a comparatively rare urinary tract infection characterized by air within the bladder wall and lumen and is usually associated with immunosuppression or poorly controlled diabetes mellitus.Case presentationWe report a case of EC in a 70-year-old man who recently underwent transrectal ultrasound needle-guided prostate biopsy, after which he underwent pylorogastrectomy. He did not have any history of diabetes mellitus or any immunosuppressive disease. The patient developed severe sepsis, requiring intravenous antibiotics and urinary catheterization. Despite therapy, the patient developed disseminated intravascular coagulopathy and acute respiratory distress syndrome. Therefore, he was admitted to the intensive care unit, antibiotic coverage was broadened, and danaparoid sodium and sivelestat sodium hydrate was administered. After 20 days, the patient’s condition improved, and on the 28th day, the patient was discharged to home in a good condition without any sequelae.ConclusionPrompt diagnosis and treatment are warranted to prevent potential morbidity of and mortality in cases of EC.

Prostate-specific antigen screening impacts on biochemical recurrence in patients with clinically localized prostate cancer

To clarify the impact of prostate‐specific antigen screening on surgical outcomes of prostate cancer.

Clinical significance of preoperative renal function and gross hematuria for intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

To investigate the predictive values of perioperative factors and to develop a nomogram for intravesical recurrence after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma.

MP49-16 FACTORS PREDICTING FAILURE TO FOLLOW PRE-SCHEDULED GEMCITABINE PLUS CISPLATIN CHEMOTHERAPY REGIMEN FOR UROTHELIAL CARCINOMA

in theACTand13.7months in thenon-ACTgroup (p1⁄40.78).ACTremained an insignificant predictor for RFS after adjusting for pT, pN and margin status (HR: 0.89, 95%CI: 0.48-1.68]). CSS was 23 and 22 months in the respective groups (p1⁄40.65) and remained insignificant after adjusting for pathologic confounders (HR: 0.67, [95%CI: 0.34-1.28]). The eight patients who received cisplatin-based chemotherapy in both neoadjuvant and adjuvant settings had the highest median RFS of 23.2 months. CONCLUSIONS: AC in this retrospective cohort of pT3-4 and/or pN+ did identify a subset with better median RFS. However, the choice of AC regimens, and incorporation of newer drugs, particularly beyond useof conventional cytotoxic drugs, in both adjuvant and neoadjuvant contexts is a key direction for improving outcomes in this high risk patient group.